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Archive for the ‘HIV’ Category

Medical Board Update: Pre-procedure consent, HIV testing

To: All Medical Staff, Housestaff, and Credentialed Providers

From: David Reich, MD
President, Medical Board
The Mount Sinai Hospital
1. HIV Testing Policy: As required by NY State, all patients 13-64 years of age and those at risk must be offered HIV testing at hospital admission, or in primary care outpatient/office and Emergency Department settings. Nursing has incorporated the assessment in workflows, but a physician or a credentialed provider (NP/PA) must counsel and consent the patient prior to testing. The seven counseling elements are as follows (abridged version):
i. HIV is the virus that causes AIDS and can be transmitted through unprotected sex, contact with blood, sharing needles, and by HIV-infected pregnant women to their infants during pregnancy/delivery/breast feeding.
ii. There are treatments for HIV/AIDS that can help an individual stay healthy.
iii. Individuals with HIV/AIDS can adopt safe practices to protect uninfected and infected people in their lives.
iv. Testing is voluntary and can be done anonymously at a public testing center (outside of Mount Sinai).
v. The law protects the confidentiality of HIV test results and other related information.
vi. The law prohibits discrimination based on an individual’s HIV status.
vii. Consent for HIV related testing remains in effect until it is withdrawn verbally or in writing.

The full policy and the DOH consent form are attached to this announcement. The DOH consent form may also be downloaded at:, and may be used until a Mount Sinai form is created.

2. Preoperative Testing Form: The new standardized form for ordering preoperative and pre-procedure testing is attached to this announcement. Requirements for laboratory testing, ECG, and chest X-ray are markedly reduced, and the pre-admission testing staff have been instructed to question any non-standard testing. Adhering to the guidelines in this template will help to minimize delays/postponement of surgery/procedures due to abnormal results and reduce costs. All perioperative nurses and anesthesiologists will consider the testing specified in the policy as sufficient to proceed with surgery.

3. Consent to Surgery/Procedure/Treatment and Anesthesia Form: The existing surgical/procedural consent form has been amended to expand “tissues” to “tissues, organs, and body fluids” so as to be more understandable for patients.

4. Prescription Pad Security: Prescription pads must always be secured in Pyxis or other locations with a high level of protection against theft or unauthorized access. This must occur in all settings, include office and outpatient areas.

5. Epic Physician Documentation: The next round of training is scheduled to be completed prior to the physician documentation go-live date of June 10th. Training will be available via e-learning and classroom modules and will take approximately four hours. Interim Chief Medical Information Officer Dr. Darrow is investigating opportunities for department-specific training.

6. Medical Student Documentation in the Medical Record: The Bylaws and the Hospital Staff Rules and Regulations will be amended to indicate that all medical student notes must be reviewed and signed by a member of the housestaff or an attending physician. Attending physicians may utilize any portion of a medical student note as part of their documentation, but may not make linking statements to notes written by medical students.

doh consent-2556
HIV Testing and Counseling Policy (A4-120)
Preop Testing Form MR1829

Written by reuben

March 5th, 2012 at 4:34 pm

HIV Testing at Elmhurst ED

HIV testing the ED

We talked about this yesterday at our attending meeting and I know there’ll be more to discuss. If you’ve worked this week you’ve probably noticed the HIV icons on the tracking board.

In order to adjust to a hospital funding change and start complying with a new New York State regulation requiring 24/7 HIV offer/testing in ED we had to change how we provide this service. The new funding source has the specific expectation of an expanded testing program throughout the hospital. We are not ready to offer testing 24/7 but will now have 16 hours of additional testing on the weekend. Unfortunately we will no longer have HIV counselors weekday evenings (between 4 and 11 PM). Instead a phlebotomist will staff these hours and can order and enter results in QMED but cannot counsel patients. An important aspect of the change for us then is, during these hours (weekdays 4 to 11pm), a doctor/PA/NP has to give the patient the test result and document the conversation in HMED.

Here is how it should work:

1 ONLY AMBULATORY patients get an HIV fact-sheet at mini-registration (“FORM A”)

2 At triage the patient is asked if they want free HIV test:
a. “YES” response gets the new icon with a check mark in the center
b. “NO” response gets the icon with a “minus” sign
c. “Strike through” (not applicable) goes to patients who have been recently tested, are positive or are arriving by ambulance

3 Consent is signed along with general consent form at registration.

4 Hours of testing:

a. Monday to Friday 9 AM to 4 PM and Saturday/Sunday 11 AM to 7 PM: HIV counselor performs test, gives result and counsels patient. They also document post-test counseling in HMED.

b. ***Monday to Friday 4 PM to 11 PM: Phlebotomist performs the test and enters result into QMED but cannot give result to patient, counsel patient or document in HMED.

i. Tech will give result to Resident/PA/NP if one is assigned
ii. Tech gives result to attending if no Resident/PA/NP is assigned

5 Post-test counseling:
a. NEGATIVE result (>99%):
i. Inform the patient
ii. PRN follow up

b. POSITIVE result (<<1%): i. Counsel patient ii. Page ID fellow and give fellow the patient’s contact information iii. Advise patient to return the next morning, with the test result sheet, to speak to the counselor and set up ID clinic follow up iv. If the patient is admitted the in-patient team will contact ID/HIV counselors 6 Document counseling a. HMED progress notes have pre-set statements that are self explanatory b. HIV counselor document in a different section of the HMED chart If you have any questions please call me 917-533-2660. Thanks, Phil Courtesy of Scott Goldberg: There is some reasonable information on the CDC website. However, the material can be vague and refers back to "following your institutions guidelines." The CDC RESPECT-2 site ( has some excellent information and scripts on what to do with a NEGATIVE result, and on how to counsel patients PRIOR to the test. The script for counseling a patient on a HIV Positive Script. It is useful, but limited.

There is also some useful information on positive test result counseling here: It includes information including the sensitivities and specificities of our rapid tests (appendix), allowing an educated discussion about what this test means with our patients.

Also, remember that at Sinai any positive should get a call to social work for counseling 24/7.


Written by reuben

December 8th, 2011 at 7:29 pm

Posted in Elmhurst,HIV

If making the diagnosis of HIV

1. JMF has agreed to see all new positives same day (if before noon)
or next day (if afternoon) as a walk-in, no appointment necessary,
they do not need to call. Just put the JMF information on the
discharge paperwork and have them bring to clinic. We are working on
making up appointment cards, these will be kept by social work (see

2. Social work on-call has agreed to come in (yes, come in) for all
new positives. You dont need to do the counseling. You CAN, but dont
need to.

Scott Goldberg

Written by reuben

October 2nd, 2011 at 6:56 pm

Posted in HIV

HIV testing no longer requires written consent

And patients who are sources in needlestick cases who cannot consent, in some cases can be tested without consent. See the document link below.

August 11, 2010
TO: (New York State)
Chief Operating Officers
Medical Directors
Emergency Medicine Chairs
Emergency Department Administrators
Legal Affairs Committee

FROM: Susan C. Waltman, Executive Vice President and General Counsel

RE: Enactment of Bill to Promote HIV Testing

On July 30, 2010, Governor David Paterson signed into law S.8227/A.11487, which allows patients to agree to HIV testing as part of a general signed consent to medical care that remains in effect until it is revoked or expires. The law also requires health care providers, including hospitals and emergency departments, to offer testing to all patients between 13 and 64 years of age, as recommended by the Federal Centers for Disease Control and Prevention (CDC), and facilitates authorization for testing in the case of certain occupational exposures to HIV infection. The new law takes effect September 1, 2010, but authorizes the New York State Commissioner of Health to adopt regulations necessary to implement the law prior to that date.

The law will require a number of operational changes within health settings, including: hospital inpatient areas, emergency departments, outpatient departments, as well as other primary care settings. To assist its members, GNYHA is working with the New York State Department of Health (DOH) to identify and address the barriers and burdens that these requirements will create for providers. GNYHA will keep you apprised of its progress on these efforts.
The law aims to increase HIV/AIDS testing rates so that individuals who are HIV-positive can seek treatment earlier and reduce transmission of the disease to others. The law, therefore, updates New York State’s laws to encourage such testing and to reflect medical technologies and advances.

Overview of Law

The following provides a summary of the main features of the law:

Testing – Requires that an HIV-related test be offered to every individual between 13 and 64 years of age (or younger/older if there is evidence of risk activity) receiving health services as an inpatient or in the emergency department of a hospital or receiving primary care services in the outpatient department of a hospital or freestanding diagnostic treatment center or from a physician, physician assistant, nurse practitioner, or midwife providing primary care. Such offering must be “culturally and linguistically appropriate.”

Consent to Testing – Authorizes HIV-related testing to be part of a signed general consent to medical care or documented oral consent when the test being ordered is a “rapid HIV test.” Such consents would be durable and remain in effect until they are revoked or expire. Patients must be provided an opportunity to decline HIV testing, and testing may only be done with full patient consent after the patient is provided with pre-test counseling information. In all instances, a physician must provide oral notification to the patient whenever an HIV test is performed and the notification must be noted in the patient’s medical record.

Occupational Exposures – In situations involving occupational exposures that create a significant risk of someone contracting or transmitting HIV infection, HIV testing will be allowed in cases where: (1) the source person is deceased, comatose, or unable to provide consent, and his or her health care provider determines that mental capacity to consent is not expected to be regained in time for the exposed person to receive appropriate medical care, as determined by the exposed person’s health care provider; (2) an authorized representative for the source person is not available or expected to become available in time for the exposed person to provide appropriate medical care; and (3) the exposed person would benefit medically by knowing the source person’s HIV test results.

HIV Counseling – Require that HIV counseling messages be tailored based upon whether the HIV test indicates infection. Required positive test counseling remains consistent with existent law, but positive test counseling will now require the person ordering the test to provide or arrange for follow-up medical care if the patient consents. In cases with negative test results, counseling can be accomplished via oral or written reference to information previously provided but must emphasize the risks associated with high-risk behaviors.
Consent Forms – Designates the informed consent forms for HIV-related testing and disclosure that the Commissioner must develop as “standardized model” forms and removes the requirement that providers obtain prior authorization for the use of alternative consent and release forms, provided that the forms contain information consistent with the standardized model forms.

A copy of the new law is attached. If you have any questions regarding the new law, please contact Maria Woods at (212) 259-0767 or


Written by reuben

August 30th, 2011 at 5:19 am

Posted in HIV,Needlestick